Huiwen Xu1, Sindhuja Kadambi2, Supriya G Mohile3, Shuhan Yang4, Lee A Kehoe5, Megan Wells6, Eva Culakova7, Charles Kamen8, Spencer Obrecht9, Mostafa Mohamed10, Nikesha J Gilmore11, Allison Magnuson12, Valerie Aarne Grossman13, Judith O Hopkins14, Jodi Geer15, Jeffrey Berenberg16, Karen Mustian17, Anapaula Cupertino18, Nimish Mohile19, Kah Poh Loh20. 1. Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Huiwen_XU@urmc.rochester.edu. 2. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Sindhuja_Kadambi@URMC.Rochester.edu. 3. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: supriya_mohile@urmc.rochester.edu. 4. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Shuhan_yang@urmc.rochester.edu. 5. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Lee_Kehoe@URMC.Rochester.edu. 6. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Megan_Wells@URMC.Rochester.edu. 7. Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Eva_Culakova@URMC.Rochester.edu. 8. Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Charles_Kamen@URMC.Rochester.edu. 9. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Spencer_Obrecht@URMC.Rochester.edu. 10. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Mostafa_Mohamed@URMC.Rochester.edu. 11. Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Nikesha_Gilmore@URMC.Rochester.edu. 12. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Allison_Magnuson@URMC.Rochester.edu. 13. SCOREboard, Rochester, NY, USA. 14. Southeast Clinical Oncology Research Consortium, Winston-Salem, NC, USA. Electronic address: johopkins@novanthealth.org. 15. Metro Minnesota Community Oncology Research Program, St Louis Park, MN, USA. Electronic address: jodi.geer@parknicollet.com. 16. Hawaii MU-NCORP, Honolulu, HI, USA. Electronic address: berenber@hawaii.edu. 17. Department of Surgery, Cancer Control, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Karen_Mustian@URMC.Rochester.edu. 18. Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Paula_Cupertino@URMC.Rochester.edu. 19. Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: Nimish_Mohile@URMC.Rochester.edu. 20. James P Wilmot Cancer Institute, Division of Hematology/Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. Electronic address: kahpoh_loh@urmc.rochester.edu.
Abstract
OBJECTIVES: Rural-urban disparities in the experiences of caregivers of older adults with advanced cancer may exist. This study examined factors associated with caregiver mastery and burden and explored whether rural-urban disparities in caregiver outcomes differed by education. MATERIALS AND METHODS: Longitudinal data (baseline, 4-6 weeks, and 3 months) on caregivers of older adults (≥ 70) with advanced cancer were obtained from a multicenter geriatric assessment (GA) trial (ClinicalTrials.gov: NCT02107443). Rurality was determined based on 2010 Rural-Urban Commuting Area codes. Caregivers' education was categorized as ≥ some college vs ≤ high school. Caregiver outcomes included Ryff Environmental Mastery (scored 7-35) and Caregiver Reaction Assessment (including self-esteem, disrupted schedules, financial problems, lack of social support, and health problems; each scored 1-5). Separate linear mixed models with interaction term of education and rurality were performed. RESULTS: Of 414 caregivers, 64 (15.5%) were from rural areas and 263 (63.5%) completed ≥ some college. Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = -1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school. CONCLUSION: Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.
OBJECTIVES: Rural-urban disparities in the experiences of caregivers of older adults with advanced cancer may exist. This study examined factors associated with caregiver mastery and burden and explored whether rural-urban disparities in caregiver outcomes differed by education. MATERIALS AND METHODS: Longitudinal data (baseline, 4-6 weeks, and 3 months) on caregivers of older adults (≥ 70) with advanced cancer were obtained from a multicenter geriatric assessment (GA) trial (ClinicalTrials.gov: NCT02107443). Rurality was determined based on 2010 Rural-Urban Commuting Area codes. Caregivers' education was categorized as ≥ some college vs ≤ high school. Caregiver outcomes included Ryff Environmental Mastery (scored 7-35) and Caregiver Reaction Assessment (including self-esteem, disrupted schedules, financial problems, lack of social support, and health problems; each scored 1-5). Separate linear mixed models with interaction term of education and rurality were performed. RESULTS: Of 414 caregivers, 64 (15.5%) were from rural areas and 263 (63.5%) completed ≥ some college. Rurality was significantly associated with more disrupted schedules (β = 0.21), financial problems (β = 0.17), and lack of social support (β = 0.11). A significant interaction between education and rurality was found, with rurality associated with lower mastery (β = -1.27) and more disrupted schedule (β = 0.25), financial problems (β = 0.33), and lack of social support (β = 0.32) among caregivers with education ≤ high school. CONCLUSION: Our study identifies subgroups of caregivers who are vulnerable to caregiving burden, specifically those from rural areas and with lower education. Multifaceted interventions are needed to improve caregivers' competency and reduce caregiving burden.
Authors: Nikesha J Gilmore; Beverly Canin; Mary Whitehead; Margaret Sedenquist; Lorraine Griggs; Lynn Finch; Valerie Grossman; Valerie Targia; Megan Wells; Charles Kamen; Marie Flannery; Allison Magnuson; Sandy Plumb; Spencer Obrecht; Lisa M Lowenstein; Gilberto Lopez; Jainy Anderson; Jeffrey Berenberg; Victor Vogel; James Bearden; William Dale; Supriya G Mohile Journal: Cancer Date: 2019-08-16 Impact factor: 6.860
Authors: Lisa M Lowenstein; Robert J Volk; Richard Street; Marie Flannery; Allison Magnuson; Ronald Epstein; Supriya G Mohile Journal: J Geriatr Oncol Date: 2018-06-06 Impact factor: 3.599
Authors: Lee A Kehoe; Huiwen Xu; Paul Duberstein; Kah Poh Loh; Eva Culakova; Beverly Canin; Arti Hurria; William Dale; Megan Wells; Nikesha Gilmore; Amber S Kleckner; Jennifer Lund; Charles Kamen; Marie Flannery; Mike Hoerger; Judith O Hopkins; Jane Jijun Liu; Jodi Geer; Ron Epstein; Supriya G Mohile Journal: J Am Geriatr Soc Date: 2019-03-29 Impact factor: 5.562
Authors: Jean A McDougall; Matthew P Banegas; Charles L Wiggins; Vi K Chiu; Ashwani Rajput; Anita Y Kinney Journal: Cancer Epidemiol Biomarkers Prev Date: 2018-03-28 Impact factor: 4.254
Authors: Tina Hsu; Matthew Loscalzo; Rupal Ramani; Stephen Forman; Leslie Popplewell; Karen Clark; Vani Katheria; Tao Feng; Rex Strowbridge; Redmond Rinehart; Dan Smith; Keith Matthews; Jeff Dillehunt; Arti Hurria Journal: Cancer Date: 2014-06-04 Impact factor: 6.860
Authors: Kah Poh Loh; Erin Watson; Eva Culakova; Marie Flannery; Michael Sohn; Huiwen Xu; Sindhuja Kadambi; Allison Magnuson; Colin McHugh; Chandrika Sanapala; Lee Kehoe; Victor G Vogel; Brian L Burnette; Vincent Vinciguerra; Supriya G Mohile; Paul R Duberstein Journal: J Geriatr Oncol Date: 2022-03-08 Impact factor: 3.929
Authors: Gina Tuch; Chandrika Sanapala; Supriya G Mohile; Paul R Duberstein; Enrique Soto-Perez-de-Celis; Huiwen Xu; Eva Culakova; Marie Flannery; Reza Yousefi-Nooraie; Ronald M Epstein; Colin McHugh; Valerie Aarne; Hannah Kim; Jodi Geer; Mark A O'Rourke; Nicholas J Vogelzang; Kah Poh Loh Journal: Oncologist Date: 2021-08-11